Multidisciplinary Coordination to Facilitate Whole Person Pain Care for Veterans

Significance: Chronic pain a highly prevalent and complex chronic disease, affecting 66% of all Veterans. VA's adoption of Whole Person Pain Care represents a major advance for delivering guideline-concordant multimodal care to address the biopsychosocial effects of chronic pain. In this approach, nonpharmacological therapies (NPTs) are delivered in combination and tailored to each patient's goals, preferences, and priorities. Strategies to coordinate this care are needed for the 84% of Veterans whose pain is managed in primary care, where multimodal therapies span disciplines and are not delivered by a formal interdisciplinary pain team. Chronic pain management is a long-standing national VA priority with goals to reduce high rates of disability, psychological comorbidities, opioid dependence, and suicide. The Comprehensive Addiction and Recovery Act, alongside a series of other national policies, have prioritized the integration of NPTs into care as first-line treatments for chronic pain. Our study fills a critical gap by identifying practices for coordinating multimodal pain care, which will inform clinical implementation and ways to coordinate this care aligned with Veteran's personal health goals. Our study also addresses VA's Strategic Priority to support Veterans' Whole Health by identifying strategies to integrate this approach into chronic pain care. Innovation and Impact: Our study will be the first to examine how to deliver Whole Person Pain Care in the absence of a formal team, using the lens of Relational Coordination (RC). This evidence-based theory focuses on communication and relationships between clinicians to achieve a common goal. We will also identify other organizational factors to develop a full picture of how and when RC impacts whole person pain outcomes. Specific Aims: Aim 1. Examine RC among clinicians delivering Whole Person Pain Care services in 36 VA medical centers (VAMCs) that offer these services. We will use a validated RC survey among 6 types of clinicians. Aim 2. Examine associations between RC and utilization of Whole Person Pain services in a cohort of Veterans with chronic pain at the 36 VAMCs that completed the RC survey. We hypothesize that stronger RC will be associated with more use of whole person pain services, and less use of opioids. Aim 3. Characterize Veterans' and clinicians' experiences of Whole Person Pain Care, barriers and facilitators to its delivery, and related coordination practices to inform future implementation. We will interview Veterans and clinicians from 8 of the 36 VAMCs that vary based on RC and whole person pain services use. Methodology: We use an explanatory sequential mixed-methods study design. Aim 1: We will conduct a validated survey to measure RC across 36 VAMCs. Aim 2: We will use administrative data to examine associations between RC and use of NPTs and opioids. Aim 3: We will conduct qualitative interviews with Veterans (n=40) and clinicians (n=80) to examine Veterans' experiences of Whole Person Pain Care as an additional outcome; and identify the contextual barriers, facilitators, and coordination practices associated with different levels of RC and NPT use in 8 purposively selected VAMCs, based on data from Aims 1 and 2. We will integrate results across the three aims to identify a set of factors that influence strong and weak RC, and key coordination practices for Whole Person Pain Care from the perspectives of both clinicians and Veterans. Path to Translation/Implementation: Operational partners in VA's Office of Patient-Centered Care and Cultural Transformation (OPCC&CT), and the Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) will use our findings to improve coordination of Whole Person Pain Care for Veterans whose pain is overseen by primary care. Our team will also leverage results to inform a future hybrid type 2 trial to implement coordination practices for Whole Person Pain Care using relational facilitation Project Number: 1I01RD000407-01A1 | Fiscal Year: 2026 | NIH Institute/Center: Veterans Affairs (VA) | Principal Investigator: Rendelle Bolton (+1 co-PI) | Institution: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL, BEDFORD, MA | Activity Code: I01 | Study Section: HSR-1 Health Care and Clinical Management[HSR1] View on NIH RePORTER: https://reporter.nih.gov/project-details/11240780